Toxicity from anticholinergic medications and from drug combinations with additive anticholinergic effects pose a serious health hazard to elderly residents of nursing homes. With the present demonstration from epidemiologic studies that psychotrophic drugs are commonly used alone or in combination with compounds known to be associated with confusional states in the elderly, the importance of characterizing this problem is clear. We propose to survey a nursing home population with standard screening tests for memory and attention and to correlate these findings with serum blood level determinations of anticholinergic activity using a radioreceptor assay. This assay will be able to detect the additive anticholinergic effects of drug combinations. Additionally, drug combinations associated with toxic levels of anticholinergic compounds can be identified. Ultimately, it is hoped that this study will lead to a drug intervention study in which drugs with anticholinergic properties can be more rationally utilized in the management of medical and behavioral problems found in elderly nursing home residents.